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Proposal

Texting to Increase Physical Activity Among Teenagers (TXT Me!): Rationale, Design, and Methods Proposal

Debbe Thompson1, PhD; Dora Cantu1, MS; Riddhi Bhatt2, MSW; Tom Baranowski1, PhD; Wendy Rodgers3, PhD; Russell Jago4, PhD; Barbara Anderson5, PhD; Yan Liu1, MS; Jason A Mendoza6, MD; Ramsey Tapia7; Richard Buday7, FAIA

1USDA/ARS Children's Nutrition Research Center, Pediatrics, Baylor College of Medicine, Houston, TX, United States
2Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
3Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
4Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
5Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
6Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
7Archimage, LLC, Houston, TX, United States

Corresponding Author:
Debbe Thompson, PhD

USDA/ARS Children's Nutrition Research Center
Pediatrics
Baylor College of Medicine
1100 Bates Street
Houston, TX, 77030
United States
Phone: 1 713 798 7076
Fax: 1 713 798 7098
Email:



ABSTRACT

Background: Physical activity decreases from childhood through adulthood. Among youth, teenagers (teens) achieve the lowest levels of physical activity, and high school age youth are particularly at risk of inactivity. Effective methods are needed to increase youth physical activity in a way that can be maintained through adulthood. Because teens text a great deal, text messages promoting walking, a low cost physical activity, may be an effective method for promoting sustainable physical activity.
Objective: The objective of our study was to determine the effect of pedometers, self selected step goals, and texts grounded in the self-determination theory (SDT) on physical activity among the teens.
Methods: “TXT Me!” was a 12 week intervention that texted 14-17 year olds to increase their daily physical activity by increasing the number of steps they take each day. The intervention was grounded in the SDT. Formative research with the teens helped construct the intervention and develop the texts. A total of 84 texts were developed (12 to set a step goal, and 72 promoting autonomy, competence, and relatedness). The pilot evaluation used a four group, randomized design (n=160). After baseline data collection, the participants were randomized to one of four conditions (no treatment control, pedometer only, pedometer + weekly prompts, pedometer + weekly prompts + SDT grounded texts). Data were collected at baseline and immediately upon completion of the study. The primary outcome was physical activity, measured by 7 days of accelerometry. Basic psychological needs, physical activity motivation, process evaluation, and program satisfaction data were also collected.
Results: To our knowledge, this is one of the first studies to explore the use of stand alone, SDT grounded texts, supported by pedometers and prompts to set a self selected step goal, as a method for increasing physical activity among teens.
Conclusions: This pilot study will contribute valuable information regarding whether theoretically grounded text messages show promise as an effective method to increase physical activity among teens.
Trial Registration: Clinicaltrials.gov NCT01482234; http://clinicaltrials.gov/ct2/show/NCT01482234 (Archived by WebCite at http://www.webcitation.org/6NYvRMOoq).

(JMIR Res Protoc 2014;3(1):e14)
doi:10.2196/resprot.3074

KEYWORDS

physical activity; pedometers; text messages; self-determination theory; adolescents



Introduction

Obesity and Chronic Diseases

Obesity has reached epidemic proportions both in the United States and other countries [1,2]. This is a major public health concern primarily because obesity increases the risk of developing chronic diseases [3], such as certain cancers [4,5], cardiovascular disease [6], and type 2 diabetes mellitus [7]. Obese adolescents are more likely to become obese adults [8], thus increasing current and future risk of chronic disease. Therefore, preventing obesity during adolescence would be of major public health significance.

Decreased Physical Activity in Adolescence

Physical activity (PA) has been inversely related to adiposity [9] and decreases risk for cardiovascular disease [10], type 2 diabetes [11], and certain cancers [12]. However, research demonstrates that PA steadily decreases from childhood through adolescence [13]. Between the ages of 6 and 16, PA decreased approximately 50%, with a continued decrease into adulthood [14]. Between early and late adolescence, moderate to vigorous PA decreased substantially among both boys (6.7 hours per week to 5.1 hours per week) and girls (5.9 hours per week to 3.5 hours per week) [15], suggesting that adolescence is a particularly vulnerable time for PA. Finding ways to avoid this decline would have a significant impact on adolescent PA and obesity risk.

Walking is a popular form of PA [16]. Walking is convenient, inexpensive, and can be easily incorporated into everyday life [17,18] in multiple ways (eg, leisure time PA, active transport) [19]. Increased walking is likely a sustainable form of PA that could be maintained over time [20]. Interventions that encourage simple activities such as walking could make substantial inroads into increasing sustainable PA [18]. Brisk walking is equivalent to moderate intensity PA [21-24]. Given the potential public health significance of walking [18], research is needed to identify effective methods for promoting walking in groups at risk of low levels of PA, such as adolescents.

Pedometers monitor daily steps, thus providing a convenient way to set goals, self monitor PA, and serve as a reminder to be active [25]. Pedometer use has been associated with increased PA in adults [26] and youth [27]. Having a step goal has been associated with decreased body mass index in adults [26]. Among youth, pedometers alone may not be enough to increase PA; other strategies to augment pedometers may be needed to promote sustained PA [27]. As there is a shortage of youth pedometer based studies, there is a need to identify effective methods for incorporating pedometers into interventions promoting walking and to evaluate the long term effectiveness of these interventions [27].

Texting and Teenagers

Cellphone ownership and texting are high among teenagers (teens) [28]. A recent study found that 77% of 12-17 year olds had a cell phone, and that texting is the primary way 14-17 year olds communicate with others (eg, friends, family) [28]. Teens are prolific users of SMS text messaging (short message service, SMS), with a median of 100 texts sent and received each day [28]. Since texting is a familiar, convenient, and acceptable way that teens communicate with others, texting may be an effective way to increase PA in this at risk group. A number of reviews of cell phone based studies suggest this intervention mode is promising [29-32]. Some characteristics of text message based interventions that appeared to enhance effectiveness were matching text message frequency to expected frequency of behavior (eg, daily PA), tailoring to selected characteristics (eg, personal values), and interactivity (eg, ability to communicate with research team) [31]. A limitation that was cited was that few of the randomized control trials using texts were theory based [32].

The Self-Determination Theory

Interventions that are based on psychological theories increase the likelihood of achieving behavior change [33]. The self-determination theory (SDT) [34] posits that three basic psychological needs underpin behavior: (1) competence (ie, skills, ability), (2) autonomy (ie, choice, control), and (3) relatedness (ie, connection to self and others). Need satisfaction (as related to the SDT) integrates the behavior into one’s sense of self (ie, how one defines him/herself). The higher the need satisfaction, the greater the integration with sense of self, thus increasing motivation to perform the behavior, behavioral performance, and the likelihood the behavior will be maintained over time [34]. The SDT has guided PA focused studies in both youth [35-44] and adults [45]. A systematic review of adult studies concluded the evidence supported the SDT as a framework for identifying key factors that influence and promote exercise [45]. Promising evidence is also emerging from youth studies. The SDT predicted autonomous motivation and step counts in youth [36], as well as intention to engage in leisure time PA [37]. The SDT explained changes in motivation to engage in school physical education in the transition from elementary to middle school [40]. An intervention with teens that focused on need satisfaction (ie, autonomy, competence, relatedness) enhanced cardiovascular fitness and was well received by youth [35]. Satisfaction of the basic psychological needs was also associated with autonomous motivation and PA in children [42]. Therefore, the SDT informed interventions promoting PA to youth that emphasize the basic psychological needs might be of particular utility in enhancing motivation to engage in PA, and, ultimately, PA.

Behavioral interventions should be systematically developed and tested [46] to maximize resource effectiveness and increase the likelihood of success. Ideally, interventions should be focused on behaviors that can be changed, evidence based, appropriate for the target population, and focused on realistic, achievable goals [46]. This paper describes the rationale, design, development, and methods for a systematically developed pilot intervention using pedometers, prompts to set a step goal, and SDT grounded text messages promoting walking (ie, increased daily steps) to teens.


Methods

Overview

This research included two phases: (1) formative, to develop the intervention and construct the text messages, and (2) pilot to assess the feasibility of this approach. Both of these phases are described below.

Participants

Teens for both phases of the research were recruited using the volunteer database at the Children’s Nutrition Research Center. The standard recruitment methods, (eg, newsletter and website announcements, distribution of flyers in community locations likely to be visited by parents and teens) were also used. The parents provided written informed consent for their teen to participate in the study, and teens provided written assent. The teens that participated in the formative phase of the program were not eligible to participate in the pilot study.

Eligible participants were 14-17 years old, fluent in English, with Internet access, an email address, and access to a cell phone with unlimited text messaging. Exclusionary criteria included mental (eg, learning impairments) or physical (eg, blindness, deafness, inability to be physically active, medical conditions that limited PA) conditions that impaired their ability to fully participate in the program and/or complete data collection. The families that were interested in participating in the study contacted the Children’s Nutrition Research Center’s Recruitment Coordinator. She explained the study in detail, screened interested families, and routed eligible teens to the study coordinator.

Intervention

Focus

This program encouraged walking (eg, attaining a certain number of daily steps), a low cost PA that does not require special equipment, membership fees (eg, gym), or a high level of fitness [17,18]. It is also an activity that has the potential to be maintained over time [20].

Formative Research

There were thirty 14-17 year olds, stratified by gender (male, female) and race/ethnicity (black, Hispanic, white) that were invited to participate in two rounds of formative research. During each round of formative research, the teens completed a Web-based survey and then participated in a telephone interview with trained research coordinators to discuss the survey responses. Probes were used to clarify and understand responses and to ensure responses were interpreted as intended.

Formative research revealed that teens had positive reactions to wearing a pedometer to help them keep track of the number of steps they took each day and to receiving daily texts to help them attain a step goal. The teens thought that attaining 12,000-15,000 steps a day would be “easy.” Most of them wanted the study to set a step goal for them, and they wanted to text their daily steps to the study. The most common reasons teens wanted to be physically active were related to appearance (eg, lose weight, be fit, appeal to opposite gender) and sports/athletics. Most of them reported having unlimited texting plans and having to adhere to family (eg, no profanity, violence, sexting) and school (eg, no texting during class) rules about texting. They also reported talking with parents, friends, especially close friends, and others, such as coaches and teachers about PA. All the teens believed that teens have control over whether they are physically active, although the amount of control they exert over whether they are physically active varied from some to total control. Most thought 6 a.m.-8 a.m. would be the ideal time to receive texts about PA.

The teens suggested keeping the text messages short (<160 characters); ensuring messages were positive, straightforward, and promoted realistic behaviors; and conveyed emotion through the use of emoticons [47], (eg, :D) and exclamation points (!). Other suggestions included ensuring the texts did not nag (eg, “Don’t forget...you’re in charge of meeting your step goal.”), or sound like school (eg, “Having a problem meeting your step goal? Make a list of ways to get extra steps. You’ve got what it takes!”). The teens also suggested not using words like “problem solving” or “brain storming,” text abbreviations (eg, “gr8” for “great”), or suggestions that were unrealistic, unclear, or too formal. In other words, the teens wanted straightforward, realistic text messages that focused on facts.

There were two types of text messages that were developed: (1) reminders to set a weekly step goal (eg, prompts), and (2) SDT grounded text messages emphasizing the basic psychological needs (ie, autonomy, competence, relatedness). The texts were vetted by the teens and a professional panel of experts in psychology, behavior change, PA, and SDT prior to use in the pilot study. Examples of modifications after the texts were reviewed by the teens are presented in Textbox 1.

Autonomy was operationalized as having choice or control over PA, while competence focused on having the skills or abilities to meet step goals and be physically active. Relatedness was operationalized as a sense of connectedness to self and important others (ie, family, friends). Connectedness to self was promoted by relating step goal attainment to personal values [48,49]. During formative assessment, the teens were shown a list of personal values that was used in a previous intervention with youth [49]. The values receiving the highest ratings were; “being healthy and fit”, “being responsible”, “being successful”, “getting good grades”, and “being a good person”. The teens did not relate to messages attempting to connect meeting a daily step goal with “being a good person”. Further, since “healthy” and “fit” are slightly different concepts, they were split and promoted separately. The final values used to promote a sense of connectedness to self were; “being healthy”, “being fit”, “being responsible”, “being successful”, and “getting good grades”. Examples of how “relatedness to self” was operationalized are presented in Table 1.

Using the formative research described above as a guide, texts were <160 characters, straightforward, realistic, and conveyed emotion through emoticons and exclamation points, actual words, rather than text abbreviations, were used. A total of 84 texts were finalized for the pilot feasibility study, 12 prompts to set a step goal, and 72 SDT grounded texts. The SDT grounded texts were evenly divided between those promoting autonomy, competence, and relatedness. Relatedness was further divided into text messages promoting a connection with self (ie, personal values) and others (ie, friends, family). Prompts were sent once a week (Sunday), and SDT grounded texts were sent 6 times a week (Monday-Saturday).


[view this box]
Textbox 1. Sample messages after formative research with teens.


[view this table]
Table 1. Texts connecting personal values to meeting step goal.

Conceptual Model

Figure 1 shows a conceptual model of the intervention. The intervention components include pedometers (to self monitor, promotes competence), prompts (to set a self selected step goal, promotes autonomy), and SDT informed text messages emphasizing the basic psychological needs within the context of daily steps (promotes autonomy, competence, relatedness). Emphasizing the basic psychological needs in the context of taking more daily steps enhances motivation to take more daily steps, which leads to increased daily steps, and ultimately, increased PA. The pilot study tests the feasibility of this approach.


[view this figure]
Figure 1. Conceptual model guiding the intervention. Self-determination theory (SDT); physical activity (PA).

Pilot Study Design

A four group design was employed: (1) no treatment control, (2) pedometer only, (3) pedometer + weekly texts to set a step goal (ie, prompts), and (4) pedometer + weekly texts to set a step goal + SDT focused text messages. This design is expected to provide insight into the additive effects of intervention components (pedometers, prompts, SDT focused text messages). Data were collected at baseline and upon completion of the 12 week intervention (post 1 data collection). The primary outcome was objectively measured PA. Randomization occurred after baseline data collection using a random numbers table. After obtaining written informed consent/assent, the participants began baseline data collection. Institutional review board approval was obtained from Baylor College of Medicine (H-27537). The study was registered with Clinicaltrials.gov prior to initiation (NCT01482234).

Procedures

Intervention

Although the formative assessment with the teens indicated their desire to have the study set a daily step goal for them, the teens were not assigned a daily step goal by the study. Goals set by others are inconsistent with the SDT and the development of higher levels of PA motivation (ie, autonomous motivation) [34]; autonomous motivation is more likely to lead to sustained PA (ie, increased daily steps) [45]. Rather, each teen’s average daily step count was extracted from baseline activity monitor data. When they were notified of their group assignment and sent a pedometer, all the teens except those randomized to the control group were told that experts recommend teens attain a daily step count of 12,000 to 15,000 [50]. They were then given their average daily step count and told that increases should be gradual. This was deemed to be general knowledge instead of a goal, since it did not adhere to the characteristics of a goal (ie, specific, moderately difficult, temporal) [51], much like the recommendation to attain 60 or more minutes of PA a day [52]. The teens in the control group received their average daily baseline step count, a pedometer, and the recommended guideline at the end of the study.

A browser based administrative software application was developed to manage participants, send texts, and view messages received from participants. The management application enabled the research team to enter participants into their assigned group after randomization. A database of the text messages (ie, prompts and theory based messages) was created and an algorithm was developed to connect message type with group. Each morning at 8 a.m., the algorithm driven application was automatically executed to query the database by group, and identify whether texts were to be sent to each group that day, and if so, which texts to send. The application then communicated with an SMS gateway provider (Clickatel), via their Web-based application programming interface to automatically send the messages. Prompts were sent each Sunday, and SDT focused texts were sent Monday-Saturday.

An additional feature in the administrative application enabled preformatted messages to be manually texted to participants by the research team through the SMS gateway. Examples of preformatted messages included texts to let the teens know that it was time for data collection and/or that the activity monitor had been sent to them by prepaid courier service. These messages were texted to all participants on an as needed basis by the research staff, regardless of group assignment.

The teens could also send texts to the research team through the SMS gateway. Research staff could manually respond to texts received by the teens during the data collection or intervention period through the SMS gateway. Although the teens were not asked to text their step goal or step attainment to the research team because of its inconsistency with the SDT, some chose to text this information to the team anyway. Examples of other types of texts received from the teens included questions, texts to let the research team know they had received a package, or other types of general communication with the research team.

The administrative management application and the SMS gateway were hosted on secure servers and accessed via a Secure Socket Layer connection. An automatic log was maintained to track all activity of the application, which included both manual and automated messages sent by the research team, message delivery (both automated and manual), messages received from the study participants, and any technical issues encountered during message delivery (automated, manual).

Data Collection

Objectively measured PA was assessed with 7 days of accelerometry (Actigraph, Limited Liability Corporation; Model GT3X+). Self reported data included the Basic Psychological Need Satisfaction Questionnaire [53], PA motivation (intrinsic, extrinsic) as measured by the expanded Behavioral Regulation in Exercise Questionnaire [54], social desirability of response [55,56], program satisfaction (post 1 only), and standard demographics (baseline only), these data were collected using a secure, password protected website. Process data were collected using the framework of Baranowski and Jago [57]. The areas emphasized included recruitment, retention, and program delivery; process data were recorded in an Access database maintained by study staff. A log of technical issues was also maintained, as was a record of texts sent to and received from participants.

Beta Testing

Extensive internal beta testing was conducted with the research staff and programmers prior to the feasibility study. A one month test of the procedures and text messages with participants who participated in the formative research was also conducted and served as a final beta test of intervention, messages, and procedures prior to the feasibility study. No technical or procedural issues were identified during the one month beta test.


Results

Pilot Study

A 12 week pilot study was initiated in August 2012 and completed in August 2013. There were one hundred and sixty 14-17 year olds that were enrolled (40/group) using the volunteer database (ie, families interested in participating in research studies) at the Children’s Nutrition Research Center and also using standard recruitment procedures (posting of flyers, posting of study details on recruitment websites and/or electronic newsletters). The teens were randomized after completing a baseline data collection. The baseline characteristics indicated that 51.9% (83/160) were female, and 60.6% (97/160) were at the lower end of the age range (ie, less than 16 years old).  The sample was ethnically diverse (35.6%, 57/160 black; 31.3%, 50/160 white; 26.9%, 43/160 Hispanic; and 6.3%, 10/160 mixed/other), respectively.  The teens wore an activity monitor for 7 days to obtain an objective measure of PA; they also completed Web-based self report questionnaires. Baseline psychometric values of the measurement scales (Cronbach alpha) were within acceptable ranges [58] (Psychological Need Satisfaction in Exercise, .87; expanded Behavioral Regulation in Exercise Questionnaire, .84). Data are currently being analyzed to determine feasibility of this approach to promote PA to teens.

Expected Outcomes

Although the pilot study was not powered to detect statistically significant differences, the group receiving pedometers + weekly prompts + SDT text messages is expected to have the greatest increase in moderate to vigorous PA and average daily steps. They are also expected to have the greatest increases in basic psychological needs, and the greatest movement towards higher levels of PA motivation. The group receiving pedometers + weekly prompts is expected to have the next greatest increase in moderate to vigorous PA, steps, psychological needs, and PA motivation, followed by the group receiving pedometers only. The control group is expected to exhibit no change in moderate to vigorous PA, steps, basic psychological needs, or PA motivation. It is also expected that recruitment goals will be met, attrition will be low, and that we will be able to collect complete data (Web-based self report, 7 days of accelerometry) in at least 75.0% (120/160) of study participants at post 1, regardless of group assignment. It is also anticipated that few technical issues will limit distribution of SMS text messaging; that program satisfaction will be high among participants, particularly in the group that received daily messages; and that the internal consistency of self report measures will be acceptable (>.70).


Discussion

Teenagers and Physical Activity

Teens are at risk of low levels of PA [15]. This is a major public health concern because low levels of PA, particularly during adolescence, have been shown to track into adulthood [14], thus increasing the risk of obesity [9] and multiple chronic diseases [10-12]. Effective interventions are needed to increase PA among this at risk group. Because walking is an activity that can be relatively easily incorporated into one’s other daily activities [17,18], interventions encouraging teens to take more steps throughout the day may be an effective way to enhance sustainable PA in this at risk group.

An Intervention for Teenagers

The intervention described here provides teens with a pedometer to self monitor their daily steps, encourages them to set a self endorsed daily step goal through once a week texts, and sends daily texts emphasizing the basic psychological needs. It extends the literature in several important ways. First, it systematically varies the intervention components (none, pedometers only, pedometers + prompts, pedometers + prompts + SDT informed texts), which will provide information on whether adding prompts or SDT informed text messages increase daily steps and PA over pedometers alone. Second, it will add to the body of literature on whether SDT informed interventions are an effective way to promote PA among teens. Text messages promoting obesity prevention behaviors have been shown to be acceptable and feasible with obese teens; however, their effect on behavior was not assessed, and they were developed as an adjunct to a weight management program rather than as a stand alone intervention [59]. The current research extends this by examining intervention effects on daily steps; specifically, it examines whether an SDT informed text message based intervention focusing on the basic psychological needs is feasible, acceptable, and influences average daily steps, motivation, and PA in teens. Third, it adds further support to the importance of conducting formative research with teens to help ensure the intervention meets their expectations [60]. Ultimately, this could enhance intervention effectiveness by designing interventions that are developmentally appropriate and relevant to the target audience, an important lesson learned for researchers conducting research with teens. Fourth, it extends the evidence regarding the relationship between pedometers and PA in teens [27]. And finally, it extends the literature on texting as a stand alone intervention modality versus as a supporting component. Although reviews provide suggestive evidence that text messages may be an effective way to promote health enhancing behaviors [29-32], few have examined it as a stand alone intervention method. A text message based intervention to increase PA in teens showed promising results; however, PA was self reported, and the intervention only lasted two weeks [61]. The current study will extend this research by using a stronger measure of PA (objectively measured), and sending text messages for 12 weeks.

Conclusions

Teens are heavy users of texting [62]. Therefore, a text based intervention encouraging teens to take more steps during the day may be an effective way to encourage them to be more physically active in a manner that has the potential to be sustained throughout life [20]. This is an important area of research; a text message based intervention would be easy to disseminate at a relatively low cost, using a familiar and convenient technology. Thus, this research ultimately has the potential for public health significance by increasing PA in an at risk group in a familiar, convenient, and relatively low cost manner.


Acknowledgments

The Eunice Kennedy Shriver National Institute of Child Health and Human Development, R21HD066305 (to Dr Thompson) supported this project. This work is also a publication of the United States Department of Agriculture, Agricultural Research Service (USDA/ARS), Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and funded in part with federal funds from the USDA/ARS under Cooperative Agreement No. 58-6250-0-008. The contents of this publication do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement from the US Government. We would like to thank the teens who participated in this research.


Authors' Contributions

DT was principal investigator and oversaw all aspects of the project; DC oversaw recruitment, data collection, intervention delivery, and assisted with message and intervention development; RBhatt managed the project during message and intervention development; TB was a coinvestigator and provided guidance on message design; TB, WR, RJ, and BA comprised the expert panel and provided assistance with text message design; YL is the study biostatistician; JM provided medical oversight during recruitment; RT architectured the message database schema, and built the administrative management application; RBuday oversaw and guided the work of RT and assisted with development of the overall structure and function of the message database and administrative application.


Conflicts of Interest

None declared.


References

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012 Feb 1;307(5):483-490. [CrossRef] [Medline]
  2. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1(1):11-25. [Medline]
  3. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992 Nov 5;327(19):1350-1355. [CrossRef] [Medline]
  4. American Cancer Society. Cancer facts & figures 2009. Atlanta: American Cancer Society; 2009.   URL: http://www.cancer.org/acs/groups/content/@nho/documents/document/500809webpdf.pdf [accessed 2014-02-26] [WebCite Cache]
  5. Ceschi M, Gutzwiller F, Moch H, Eichholzer M, Probst-Hensch NM. Epidemiology and pathophysiology of obesity as cause of cancer. Swiss Med Wkly 2007 Jan 27;137(3-4):50-56 [FREE Full text] [Medline]
  6. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics 1999 Jun;103(6 Pt 1):1175-1182. [Medline]
  7. Hussain A, Claussen B, Ramachandran A, Williams R. Prevention of type 2 diabetes: A review. Diabetes Res Clin Pract 2007 Jun;76(3):317-326. [CrossRef] [Medline]
  8. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997 Sep 25;337(13):869-873. [CrossRef] [Medline]
  9. Salbe AD, Weyer C, Harper I, Lindsay RS, Ravussin E, Tataranni PA. Assessing risk factors for obesity between childhood and adolescence: II. Energy metabolism and physical activity. Pediatrics 2002 Aug;110(2 Pt 1):307-314. [Medline]
  10. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, American Heart Association Council on Clinical Cardiology Subcommittee on Exercise‚ Rehabilitation‚ Prevention, American Heart Association Council on Nutrition‚ Physical Activity‚ Metabolism Subcommittee on Physical Activity. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: A statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003 Jun 24;107(24):3109-3116 [FREE Full text] [CrossRef] [Medline]
  11. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, American College of Sports Medicine, American Diabetes Association. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010 Dec;33(12):e147-e167 [FREE Full text] [CrossRef] [Medline]
  12. World Cancer Research Fund & American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: A global perspective. Washington, DC: American Institute for Cancer Research; 2007.
  13. Nader PR, Bradley RH, Houts RM, McRitchie SL, O'Brien M. Moderate-to-vigorous physical activity from ages 9 to 15 years. JAMA 2008 Jul 16;300(3):295-305. [CrossRef] [Medline]
  14. Sallis JF, Simons-Morton BG, Stone EJ, Corbin CB, Epstein LH, Faucette N, et al. Determinants of physical activity and interventions in youth. Med Sci Sports Exerc 1992 Jun;24(6 Suppl):S248-S257. [Medline]
  15. Nelson MC, Neumark-Stzainer D, Hannan PJ, Sirard JR, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics 2006 Dec;118(6):e1627-e1634 [FREE Full text] [CrossRef] [Medline]
  16. Simpson ME, Serdula M, Galuska DA, Gillespie C, Donehoo R, Macera C, et al. Walking trends among US adults: The Behavioral Risk Factor Surveillance System, 1987-2000. Am J Prev Med 2003 Aug;25(2):95-100. [Medline]
  17. Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, Scottish Physical Activity Research Collaboration. Interventions to promote walking: Systematic review. BMJ 2007 Jun 9;334(7605):1204 [FREE Full text] [CrossRef] [Medline]
  18. Lee IM, Buchner DM. The importance of walking to public health. Med Sci Sports Exerc 2008 Jul;40(7 Suppl):S512-S518. [CrossRef] [Medline]
  19. Centers for Disease Control and Prevention (CDC). Vital signs: Walking among adults--United States, 2005 and 2010. MMWR Morb Mortal Wkly Rep 2012 Aug 10;61(31):595-601 [FREE Full text] [Medline]
  20. Hillsdon M, Thorogood M. A systematic review of physical activity promotion strategies. Br J Sports Med 1996 Jun;30(2):84-89 [FREE Full text] [Medline]
  21. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR, Montoye HJ, Sallis JF, et al. Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc 1993 Jan;25(1):71-80. [Medline]
  22. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000 Sep;32(9 Suppl):S498-S504. [Medline]
  23. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C, et al. 2011 Compendium of physical activities: A second update of codes and MET values. Med Sci Sports Exerc 2011 Aug;43(8):1575-1581. [CrossRef] [Medline]
  24. Ridley K, Ainsworth BE, Olds TS. Development of a compendium of energy expenditures for youth. Int J Behav Nutr Phys Act 2008;5:45 [FREE Full text] [CrossRef] [Medline]
  25. Tudor-Locke C. Taking steps toward increased physical activity: Using pedometers to measure and motivate. Washington, DC: President's Council on Physical Fitness and Sports; 2002.   URL: http://eric.ed.gov/?id=ED470689 [accessed 2014-02-27] [WebCite Cache]
  26. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: A systematic review. JAMA 2007 Nov 21;298(19):2296-2304. [CrossRef] [Medline]
  27. Lubans DR, Morgan PJ, Tudor-Locke C. A systematic review of studies using pedometers to promote physical activity among youth. Prev Med 2009 Apr;48(4):307-315. [CrossRef] [Medline]
  28. Lenhart A. Teens, smartphones & texting. Washington, DC: Pew Internet & American Life Project; 2012 Mar 19.   URL: http://www.pewinternet.org/2012/03/19/teens-smartphones-texting/ [accessed 2014-02-27] [WebCite Cache]
  29. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: A systematic review. Telemed J E Health 2009 Apr;15(3):231-240. [CrossRef] [Medline]
  30. Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev 2009(4):CD006611. [CrossRef] [Medline]
  31. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med 2009 Feb;36(2):165-173. [CrossRef] [Medline]
  32. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev 2010 Apr;32(1):56-69 [FREE Full text] [CrossRef] [Medline]
  33. Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med 1998 Nov;15(4):266-297. [Medline]
  34. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000 Jan;55(1):68-78. [Medline]
  35. Springer JB. "I am very, very proud of myself": Improving youth activity levels using self-determination theory in program development. Front Public Health 2013;1:46 [FREE Full text] [CrossRef] [Medline]
  36. Standage M, Gillison FB, Ntoumanis N, Treasure DC. Predicting students' physical activity and health-related well-being: A prospective cross-domain investigation of motivation across school physical education and exercise settings. J Sport Exerc Psychol 2012 Feb;34(1):37-60. [Medline]
  37. Standage M, Duda JL, Ntoumanis N. A model of contextual motivation in physical education: Using constructs from self-determination and achievement goal theories to predict physical activity intentions. J Educ Psychol 2003;95(1):97-110. [CrossRef]
  38. Plotnikoff RC, Costigan SA, Karunamuni N, Lubans DR. Social cognitive theories used to explain physical activity behavior in adolescents: A systematic review and meta-analysis. Prev Med 2013 May;56(5):245-253. [CrossRef] [Medline]
  39. Smith JJ, Morgan PJ, Plotnikoff RC, Dally KA, Salmon J, Okely AD, et al. Rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) group randomized controlled trial: An obesity prevention intervention for adolescent boys from schools in low-income communities. Contemp Clin Trials 2014 Jan;37(1):106-119. [CrossRef] [Medline]
  40. Ullrich-French S, Cox AE. Normative and intraindividual changes in physical education motivation across the transition to middle school: A multilevel growth analysis. Sport Exerc Perform Psychol 2013;[epub ahead of print]. [CrossRef]
  41. Hagger MS, Chatzisarantis NL, Barkoukis V, Wang CK, Baranowski J. Perceived autonomy support in physical education and leisure-time physical activity: A cross-cultural evaluation of the trans-contextual model. J Educ Psychol 2005;97(3):376-390. [CrossRef]
  42. Sebire SJ, Jago R, Fox KR, Edwards MJ, Thompson JL. Testing a self-determination theory model of children's physical activity motivation: A cross-sectional study. Int J Behav Nutr Phys Act 2013;10:111 [FREE Full text] [CrossRef] [Medline]
  43. Jago R, Edwards MJ, Cooper AR, Fox KR, Powell J, Sebire SJ, et al. Action 3:30: Protocol for a randomized feasibility trial of a teaching assistant led extracurricular physical activity intervention. Trials 2013;14:122 [FREE Full text] [CrossRef] [Medline]
  44. Jago R, Sebire SJ, Cooper AR, Haase AM, Powell J, Davis L, et al. Bristol girls dance project feasibility trial: Outcome and process evaluation results. Int J Behav Nutr Phys Act 2012;9:83 [FREE Full text] [CrossRef] [Medline]
  45. Teixeira PJ, Carraça EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: A systematic review. Int J Behav Nutr Phys Act 2012;9:78 [FREE Full text] [CrossRef] [Medline]
  46. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med 2009 May;36(5):452-457 [FREE Full text] [CrossRef] [Medline]
  47. Huang AH, Yen DC, Zhang X. Exploring the potential effects of emoticons. Information & Management 2008 Nov;45(7):466-473. [CrossRef]
  48. Thompson D, Baranowski T, Buday R, Baranowski J, Juliano M, Frazior M, et al. In pursuit of change: Youth response to intensive goal setting embedded in a serious video game. J Diabetes Sci Technol 2007 Nov;1(6):907-917 [FREE Full text] [Medline]
  49. Thompson D, Bhatt R, Lazarus M, Cullen K, Baranowski J, Baranowski T. A serious video game to increase fruit and vegetable consumption among elementary aged youth (Squire's Quest! II): Rationale, design, and methods. JMIR Res Protoc 2012;1(2):e19 [FREE Full text] [CrossRef] [Medline]
  50. Tudor-Locke C, Pangrazi RP, Corbin CB, Rutherford WJ, Vincent SD, Raustorp A, et al. BMI-referenced standards for recommended pedometer-determined steps/day in children. Prev Med 2004 Jun;38(6):857-864. [CrossRef] [Medline]
  51. Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. Am Psychol 2002 Sep;57(9):705-717. [Medline]
  52. US Department of Health and Human Services - Physical Activity Guidelines Advisory Committee. 2008 Physical activity guidelines for Americans. Washington, DC: US Department of Agriculture: Department of Health and Human Services; 2008.   URL: http://www.health.gov/paguidelines/guidelines/default.aspx [accessed 2014-02-27] [WebCite Cache]
  53. Wilson PM, Rogers WT, Rodgers WM, Wild TC. J Sport Exerc Psychol. 2006. The psychological need satisfaction in exercise scale   URL: https://selfdeterminationtheory.org/SDT/documents/2006_WilsonRogersWild_JSEP.pdf [accessed 2014-03-04] [WebCite Cache]
  54. Wilson PM, Rodgers WM, Loitz CC, Scime G. "It's Who I Am…Really!" The importance of integrated regulation in exercise contexts. J Appl Biobehav Res 2006;11:79-104. [CrossRef]
  55. Reynolds CR, Paget KD. School Psych Rev. 1983. National normative and reliability data for the Revised Children’s Manifest Anxiety Scale   URL: http:/​/www.​researchgate.net/​publication/​232465988_National_normative_and_reliability_data_for_the_revised_Children’s_Manifest_Anxiety_Scale [accessed 2014-03-04] [WebCite Cache]
  56. Dadds MR, Perrin S, Yule W. Social desirability and self-reported anxiety in children: An analysis of the RCMAS Lie scale. J Abnorm Child Psychol 1998 Aug;26(4):311-317. [Medline]
  57. Baranowski T, Jago R. Understanding the mechanisms of change in children's physical activity programs. Exerc Sport Sci Rev 2005 Oct;33(4):163-168. [Medline]
  58. Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ 2011 Jun 27;2:53-55. [CrossRef]
  59. Woolford SJ, Clark SJ, Strecher VJ, Resnicow K. Tailored mobile phone text messages as an adjunct to obesity treatment for adolescents. J Telemed Telecare 2010;16(8):458-461 [FREE Full text] [CrossRef] [Medline]
  60. Thompson D, Cullen KW, Boushey C, Konzelmann K. Design of a website on nutrition and physical activity for adolescents: Results from formative research. J Med Internet Res 2012;14(2):e59 [FREE Full text] [CrossRef] [Medline]
  61. Sirriyeh R, Lawton R, Ward J. Physical activity and adolescents: An exploratory randomized controlled trial investigating the influence of affective and instrumental text messages. Br J Health Psychol 2010 Nov;15(Pt 4):825-840. [CrossRef] [Medline]
  62. Lenhart A. Teens and mobile phones over the past five years: Pew Internet looks back. Washington, DC: Pew Internet & American Life Project; 2009 Aug 19.   URL: http:/​/www.​pewinternet.org/​2009/​08/​19/​teens-and-mobile-phones-over-the-past-five-years-pew-internet-looks-back/​ [accessed 2014-02-27] [WebCite Cache]


Abbreviations

PA: physical activity
SDT: self-determination theory
SMS: short message service
teens: teenagers
USDA/ARS: United States Department of Agriculture, Agricultural Research Service



Edited by G Eysenbach; submitted 07.12.13; peer-reviewed by D Lubans, D Kerr; comments to author 19.01.14; revised version received 04.02.14; accepted 04.02.14; published 12.03.14

Please cite as:
Thompson D, Cantu D, Bhatt R, Baranowski T, Rodgers W, Jago R, Anderson B, Liu Y, Mendoza JA, Tapia R, Buday R
Texting to Increase Physical Activity Among Teenagers (TXT Me!): Rationale, Design, and Methods Proposal
JMIR Res Protoc 2014;3(1):e14
URL: http://www.researchprotocols.org/2014/1/e14/
doi: 10.2196/resprot.3074
PMID: 24622344

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Copyright

©Debbe Thompson, Dora Cantu, Riddhi Bhatt, Tom Baranowski, Wendy Rodgers, Russell Jago, Barbara Anderson, Yan Liu, Jason A Mendoza, Ramsey Tapia, Richard Buday. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 12.03.2014.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.